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Persistent cardiovascular (CV) risk after acute infection highlights the need for accessible tools to quantify microvascular health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The \u201cAll Eyes on PCS\u201d is a prospective observational study assessing the microcirculation using retinal vessel analysis (RVA). Both dynamic and static parameters (DVA and SVA) were compared across never SARS-CoV-2 infected individuals (NI,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200996), SARS-CoV-2 recovered individuals (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009102), and PCS patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009102), including a subgroup fulfilling ME\/CFS criteria (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200962). Analyses were complemented by propensity score-based weighting and multivariable adjustment. Associations with symptom severity and circulating biomarkers of endothelial dysfunction and inflammation were examined.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PCS patients showed reduced venular flicker-induced dilation compared with recovered individuals (3.7% \u00b1 2.2 vs. 4.8% \u00b1 3.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) and narrower retinal arterioles (CRAE) compared with both recovered (178.3\u2009\u00b1\u200915.5\u00a0\u03bcm vs. 186.1\u2009\u00b1\u200915.7\u00a0\u03bcm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and NI individuals (184.4\u2009\u00b1\u200914.3\u00a0\u03bcm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009). Arteriolar-to-venular ratio (AVR) was lower in PCS compared with NI (0.83\u2009\u00b1\u20090.06 vs. 0.87\u2009\u00b1\u20090.06,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and recovered participants (0.86\u2009\u00b1\u20090.07,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034). Findings remained largely consistent after age and sex balancing and adjustment for CV risk factors, although the association for AVR was attenuated. PCS patients fulfilling ME\/CFS criteria showed the most pronounced retinal microvascular alterations, and a combined model discriminated ME\/CFS patients with good accuracy (AUC\u2009=\u20090.79). Higher symptom burden was associated with lower AVR (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u2212\u20090.21,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.037), particularly for neurocognitive symptoms. IL-6, ICAM-1, and VCAM-1 were elevated in PCS and ME\/CFS, and lower AVR was associated with inflammatory and iron-related markers (all adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PCS is associated with persistent endothelial dysfunction, most pronounced in ME\/CFS patients and linked to symptom severity and ongoing inflammation. These findings support the potential use of RVA as a non-invasive tool for assessing and monitoring endothelial health in post-viral syndromes, with implications for cardiovascular risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>The All Eyes on PCS Study has previously been registered at ClinicalTrials.gov (NCT05635552).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-026-05144-9","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T03:46:02Z","timestamp":1787111162000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Microvascular remodeling and endothelial dysfunction across the post-COVID-19 spectrum: a prospective observational case-control study"],"prefix":"10.1186","volume":"24","author":[{"given":"Timon","family":"Wallraven","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"G\u00fcnthner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Lethen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ribeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Lech","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederike Cosima","family":"Oertel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas Gabriel","family":"Ree\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Haller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Streese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henner","family":"Hanssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Basta-Wunderle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Schmaderer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"issue":"1","key":"5144_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jmii.2022.10.003","volume":"56","author":"CC Lai","year":"2023","unstructured":"Lai CC, Hsu CK, Yen MY, Lee PI, Ko WC, Hsueh PR, Long COVID. 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All participants provided written informed consent prior to participation. The study was registered at ClinicalTrials.gov (NCT05635552).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"TW, RG, IL, AR, ML, LR, BH, LS, HH, MW, and CS declare that they have no competing interests. FCO reports current research funding from the German Research Foundation (DFG; TRR418), the Hertie Foundation, the German ME\/CFS Foundation, Novartis, and UCB, all unrelated to this project. She reports past fellowship support from the American Academy of Neurology and the National Multiple Sclerosis Society (until 2023), and past research funding from the German Neurological Society (DGN) and the DFG-TWAS program. FCO reports speaker honoraria from UCB and Novartis, and travel support from the Guthy-Jackson Charitable Foundation, the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), and the American Academy of Neurology. She serves as academic editor at DGNeurologie and Neurological Research & Practice, is a board member of the IMSVISUAL consortium, and co-chairs the Committee for Neuro-ophthalmology and Neuro-otology of the German Neurology Association. None of the authors is a member of the BMC Medicine Editorial Board.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"456"}}